Information Sheets

Terms of Use

Migraine

What is Migraine?

Migraine is an often inherited symptom complex characterized by periodic attacks of headache which are often unilateral and which may be associated with irritability, nausea, vomiting, constipation, diarrhea and light or noise sensitivity. The headache may be preceded by an ‘aura’, which most often takes the form of a visual change such as wavy lines, jagged lines, missing spots in the visual field or sparkling lights.

The earliest recognition of a headache syndrome involving one side of the head with gastrointestinal distress and visual disturbances is usually attributed to Aretaeus of Cappadocia (second century AD). Thomas Willis (1621-1675) wrote the first modern monograph on migraine and called attention to the fact that blood vessel spasm or dilatation might play a role in the genesis of the disorder. The classic report by Graham and Wolff contained the first comprehensive set of assumptions about the cause of migrainous symptoms (1938).

Current understanding of migraine has progressed significantly and suggests that migraine is actually a complex biochemical disorder of the brain with associated vascular (blood vessel) changes. Diagnosis is now helped by specific guidelines produced by medical associations and international groups (see below) which aid in differentiating it from other types of headache. All of these classifications require that there be a normal neurologic exam and no evidence of other disease that could cause headaches

A number of studies have shown that the early part of migraine is associated with a reduced blood flow in the gray matter of the posterior (back) part of the brain, on the opposite side to that affected by the aura (Olesen et al 1990;Cutrer et al 1998). Several brain chemicals are implicated in the production of migraine, but the neurotransmitter serotonin is felt to have particular importance.

Positron emission tomography (PET) scans taken during acute migraine attacks point to the importance of brainstem structures (the part that connects the upper brain to the spinal cord) as important in the genesis of migraine

Is all migraine the same?

Migraine is very common and often problematic for those who suffer from it, but it varies greatly in its manifestation. About 20% to 40% of the patients have auras. The unilateral (one sided) nature of the headache has been stressed but is present in only about 60% of patients (Lance and Anthony 1966;Olesen 1978;Sjaastad et al 1989). The pain of migraine is typically described as throbbing or pulsating, but may be that way in fewer than one-half of adults (Olesen 1978). On the other hand, between 15% and 20% of patients report that only 1 side of the head is involved throughout life (side-locked unilaterality).

What can I do about it?

Become informed! Talk to your doctor and do some reading from reputable sources. Identify the overall profile of your headache by filling out a headache history form which you can print out and take to your doctor.

For many patients, the identification of ‘trigger factors’ is essential for successful headache management; removal of individual precipitants may substantially reduce the frequency of their attacks. Trigger factors may include certain foods, changes in sleep pattern or activity, stress, and hormonal fluctuations. The best way to keep track of trigger factors and response to medication use is to keep a diary of your headaches. To download a headache diary in .pdf format click here (requires adobe acrobat reader – click here to download).

If alteration of lifestyle and avoidance of trigger factors is insufficient to control migraine symptoms, medication may be needed. These are divided into two broad groups: prophylactic medication and acute or intermittent medications. Prophylactic medication, which is taken every day to prevent headache onset, is used when the headaches are quite frequent and disabling, usually more than one headache every two weeks. Intermittent medications are those taken at the onset of symptoms to shorten or abort them. Consult your physician about which approach would be best for you Always know what medication you are taking and why. Avoid overuse of painkillers, as that may eventually make your headache pattern worse.

R. O'Brien MD

This data is provided for informational purposes only. It does not substitute for individualized advice from a qualified physician. Although attempts have been made to ensure the material is accurate and up to date it is provided in an 'as is' state. Neither the author nor neurology BC assumes any liability for errors or omissions or any problems that might arise due to them. Always consult your physician or qualified health professional before acting on information that concerns your health.